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California rates for HCPCS 42200

Palatoplasty for cleft palate, soft and/or hard palate only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $10,000.00 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $4,466.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $11,481.54 / $17,782.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,122.02 / $2,187.76
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $5,370.32 / $13,182.57
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,318.26 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $3,715.35 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,148.15 / $2,187.76
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,318.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $2,630.27
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $42,657.95
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $9,772.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,148.15 / $2,344.23
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,023.29 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $11,748.98 / $25,118.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $977.24 / $1,949.84